A large real-life test of birth control methods found more U.S. women got pregnant while using short-acting methods such as pills, patches and vaginal rings — and the failure rate was highest when they were used by women under 21.

In a new study published on Wednesday in the New England Journal of Medicine, about 7,500 women and teens in the St. Louis area were allowed to pick from a variety of contraception methods at no cost.

Over the course of the study — more than three years for women who completed all follow-up interviews — participants had a total of 334 unintended pregnancies. For the full study, see: bit.ly/KdMCQp

“We found that participants using oral contraceptive pills, a transdermal patch or a vaginal ring had a risk of contraceptive failure that was 20 times as high as the risk among those using long-acting reversible contraception,” said the research team, led by Dr. Brooke Winner of Washington University School of Medicine in St. Louis.

Previous research had suggested that more women have unintended pregnancies when they use contraception that requires daily or weekly use. But those findings came from national surveys where women tried to remember when they became pregnant and which contraceptive method they were using three or four years earlier.

“If I try to remember what I had for dinner two days ago, I can’t,” Winner told Reuters Health. “So you can imagine that those retrospective studies are not very reliable.”

In the study led by Winner, some of the unplanned pregnancies occurred when women weren’t using their chosen contraception and instead relied on a condom or the pull-out method, in which the male withdraws before ejaculation.

Still, among about 1,500 women who chose to use a contraceptive pill, patch or ring, between 4 and 5 percent became pregnant while using those methods each year.

In comparison, 0.3 percent — about one in 330 — of the 5,800 women who opted for an IUD or skin implant had an unplanned pregnancy each year because of contraceptive failure.

Just 176 women chose to get Depo-Provera hormone shots every three months, and two of them became pregnant during the study.

Depending on the brand, IUDs can prevent pregnancy for five to 10 years. Skin implants last for three years.

AGE IMPACTS RATE OF UNPLANNED PREGNANCIES

The effectiveness of the methods varied with age: women under the age of 21 who used pills, the patch or a vaginal ring had almost twice as many unintended pregnancies as older women who used those methods, the researchers reported.

Half of all pregnancies in the United States are now unintended — about 3 million annually, according to statistics from the Centers for Disease Control and Prevention.

About half of those, in turn, are in women who have been using contraception and either do not use it properly, or the method fails. Of those unintended pregnancies, 1.2 million or so lead to abortions.

The rate of unintended pregnancies in the United States tends to be higher than in other developed nations, the researchers said.

They found that women who asked for pills, a patch or a ring were less likely to have given birth before or have had an unintended pregnancy, abortion or sexually transmitted disease compared with participants who selected other methods.

IUDs and implants usually cost more than $500 and typically aren’t covered by insurance, she said.

“Nationally, only about 5 percent are using long-lasting methods like IUDs and implants. We know one of the barriers to why they’re not using them more frequently is up-front costs,” Winner added.

“One of the beauties of this study is that it shows that when you take cost out of the equation and you educate women objectively and effectively, about 75 percent of them chose a long-acting method,” she said.

“If that many women were using these products nationally, there would be a very significant drop in unintended pregnancies, which would have far-reaching effects.”

So.

Just a few extra notes and thoughts from us: this data is reflective of what we've observed over the years at Scarleteen, not just in terms of pregnancies, but in terms of pregnancy scares and users having a hard time using a method properly.

In the past, we’ve quoted data which found that for teens, specifically, birth control pills can be MUCH less effective than for older people:

Some adolescent-specific studies on the pill have shown that it is less effective for adolescents in typical use than it is for adults. One study found that teens' ability to use the pill properly was as low as only 45% with the first three months of use, and 33% with one year of use.

Why is that? It's most likely a typical use issue: in other words, not about the pill, when used properly, working less well on younger bodies, but about younger people either not using it properly or, as data like the above reflects, not using it properly over time, like doing a great job with proper use the first pack or two, then getting less great about it, or having trouble continuing to be able to get it, get it on time, or to continue to be able to afford an ongoing prescription consistently. Our impression has also been young people who are trying to hide pill use from parents also, understandably, have a tougher time using the pill properly. When you can only take it in secret, it's way harder to take it on time. Long-acting contraceptives, for the record, can all be hidden by design, which is a boon in this situation and/or for those currently unable to leave relationships where there is sexual abuse or reproductive coercion.

It might have something to do with levels of fertility under 21, but I've yet to see any data to support that theory. Thus, no need to panic if you do use methods like the pill, patch or ring, or like the condom and have an established pattern of using them consistently and correctly over years. If you're using them as perfectly as possible, it is not likely those methods will fail you. This really is, from everything we know, about how they're used (or not used).

As you may have experienced, birth control pills, specifically, are often what some healthcare providers, especially providers in general practice rather than those specifically working in OB/GYN and/or sexual health, will automatically give to people first asking about contraception. If that's what you have experienced or do experience, rather than a provider working with you to try and help you find your own best method, and you don't want the pill, or aren’t very, very sure you really can take a pill around the same time, every single day over months or years (you can test that, if you want, by seeing if you can take a multivitamin around the same time daily for a few months), and/or can back up the pill with a second method, like condoms, do yourself a favor and ask your provider to tell you about ALL available methods and do consider all of them, rather than only looking at what someone you know uses or what you've heard of before.

If your provider won’t do that, seek out a new provider. You can always ask us for help finding one: we’re always glad to help you do that. You can also check our database for providers near you.

Another biggie? We hear from a lot of people who nix a given method out of hand because one or two people they know became pregnant while using it.

Here's the reality check on that: those of us who work in contraception or sexual health, know people who have become pregnant while using EVERY method there is, just like we know people who have NOT using every method there is. That's because we talk to a lot of people every day about contraception, not just a few people here and there. That's also because NO method of contraception is 100% effective, and, especially with user-controlled methods, so many people do not or cannot use methods consistently or correctly. Heck, many people who say they're using a given method aren't using one at all.

Be sure when looking into a method that you remember that all reliable methods can fail, and all reliable methods can work, and when someone has a method that's right for them, and that they use without fail and properly, unintended pregnancy is highly unlikely. So, when we're shopping for a method and we want to prevent pregnancy as best we can, our focus should be on broad studies of effectiveness -- not what friends or family say, or ads for methods -- and our own unique selves and lives.

Image: Syracuse University Health Services/World Health Organization

Also: if you are a young person who wants an IUD and your healthcare provider is telling you you cannot have one on the basis of never having been pregnant or delivered, PLEASE know, as we’ve said before, that is outdated information. You can either ask your provider to please review the current guidelines OR seek out a different provider more current in their education and practice.

Like the report from Reuters pointed out, one big barrier to LARCs for a lot of people is that while, over time, they're less expensive than pills or patches, they cost way more right from the start. So, they're less accessible to a lot of people than those other methods.

If you'd like a method like an IUD or implant, but the cost is in your way, check to see if your state or nation has any programs you can use for contraceptive coverage. Often, areas with programs that cover contraception cover all methods, including the spendy ones. And in many areas, those programs are open more to younger people -- in some, that even includes young people covered under a parent's insurance -- than older people, so now could be a great time to get a method for cheap or for free which can potentially cover you for months, years or as long as a a decade. Bonus.

If, like all the people in this study, you know you do not want to become pregnant any time soon, but know that you will engage in the kind of sex that can create a pregnancy, the only way you can greatly reduce your risk of pregnancy is not only to use at least one -- and ideally two, especially if you are not using a long-acting contraceptive -- reliable method of contraception, and a method you feel good about and really fits your life. One person's best method is another person's worst, even if they both have the same rate of effectiveness.

Birth control methods are a whole lot like shoes or best friends: the pair or person that fits us best will fit someone else horribly. And just like shoes or friends, what fit us once may not stay a good fit as we, our lives or our circumstances grow or change, so if a method you could use well in the past is one that isn't fitting your life now, look into a switch so you can be sure that what you're using is most likely to work for you.

Comments

Thu, 2012-05-24 12:46

Anonymous

Are there more or less side effects when using a long-acting contraceptive? For instance, I've experienced low sex drive, and have read that traditional birth control methods like the pill/patch/ring (I use NuvaRing) can be the cause due to hormones and blocking testosterone release.

Also, I've been hearing about pelvic/uterine/vaginal pain associated with IUDs after the fact and over time. Is this a common occurence?

Thu, 2012-05-24 13:09

Heather Corinna

More/less when it comes to side effects isn't a sound framework, because most methods -- and certainly all LARCs and all BC pills, patches and rings -- have potential benefits and potential side effects, and yet which of either a user experiences varies widely based on the individual person and their individual body.

So, someone can use, say, the pill and not find it has any impact on libido, but use Depo and find that it does, while someone else can have the opposite experience.

Too, a method like Depo is a very different things from, say, a Paraguard IUD: just because they're both long-acting doesn't mean they work the same way and thus, have similar possible side effects.

In the blog post up there, we link to our Birth Control Bingo, where we have a page for every method and those pages include common potential side effects for all of them.

I don't know of any association with IUD use and chronic pain for most users, but certainly some may experience that.

Your best bet when considering any method is to look up the specifics of that method and then also talk, in-depth, to your sexualhealthcare provider, who can bring what they know about the method and their review of your unique health and health history to the table to give you a sound assessment of what you might experience with a given method.

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